Respiratory pathophys Flashcards
Upper respiratory
above the larynx
pharyngitis, otitis media, sinusitis
Lower respiratory tract
below the larynx
acute bronchitis, chronic bronchitis, pneumonia, TB
Defense mechanisms against infections, URT
nasal hairs, gag reflex, epiglottis, mucosal lymphoid tissue, secretory immunoglobulins
Defense mechanisms against infection, LRT
secretory IGA, ciliated epithelium, bronchospasm, cough reflex, alveolar macrophages
Conditions that impair host defenses
Cigarette smoking
Intubation
Recurrent laryngeal nerve damage
Absent gag reflex
Cystic fibrosis
Congenital absence of IgA
Oversedation
Cigarette smoking
paralyzes cilia, destroys epithelium, decreases number of macrophages, decreases macrophages’ activity
Intubation
impairment of host defenses, bypasses upper respiratory tract
Recurrent laryngeal nerve damage
at risk during surgeries
speech, swallowing, coughing
Absent gag reflex
1/3 individuals don’t have it, increased risk for aspiration
Cystic fibrosis
overproduction of thick sputum, risk for increased infection
Congenital absence of IgA
increased risk for infection
Oversedation
decreases ability to cough
usually occurs was opiates or other CNS depressants
Pathogenesis of lower respiratory tract infections
- nasopharyngeal colonization with the organism and subsequent aspiration of nasopharyngeal secretions
- reflux of GI bacteria and aspiration of contents in presence of antacid use
Acute bronchitis
D: inflammation of bronchial mucosa and increased endobronchial mucus production, due to infection
E: viral and seasonal
CP: dry cough or cough with purulent or mucoid sputum. myalgias, sore throat
T: no antibiotics
Pneumonias
inflammation of lungs with consolidation (something in lungs besides air
can be bacterial (community, nosocomial, aspiration), viral, mycoplasma
Atelectasis
partial or complete collapse of lung
_____ can lead to aspiration pneumonia
dysphagia
Dysphagia
difficulty swallowing, can lead to aspiration pneumonia
How can we prevent aspiration?
NPO
Positioning, semiupright in bed with HOB >30 (semi-fowler and fowler’s)
Clinical Presentation of Bacterial pneumonia
abrupt onset of high fever
chills, cough with purulent sputum
chest pain, dyspnea, myalgias, malaise, tachycardia
altered mental status in elderly
Diagnosis and Treatment of Bacterial Pneumonia
DX: hx, physical exam, chest xray, blood cultures, sputum culture, WBC count
Treatment: ABX, bronchodilators, airway clearance techniques
Outcome of bacterial pneumonias
Good in young and middle-aged, little or no permanent defect
elderly can die, 30-50% in bacteremic pneumonia. Harder to diagnose
Clinical presentation & Diagnosis of Viral pneumonia
S/S: fever, dry cough, myalgias, tachypnea, flu-like symptoms, scattered crackles, hypoxemia
DX: History, PE, CXR
Treatment and Outcome Viral Pneumonias
Treatment: symptomatic, no ACTs
Outcome: usually resolvles w/out complications or lasting damage, mortality <5%.
Covid-19 is an example